Perm Medical Journal

”Perm Medical Journal” (ISSN Key title: Permskiĭ medit︠s︡inskiĭ zhurnal) is a referred scientific and practical journal. It was founded in 1923 by Medical Society of Perm University. Since 2001 the founders of “Perm Medical Journal” are Perm State Academy of Medicine and Perm Research Center of Russian Academy of Medicl Sciences and Administration of Perm Region. Since 2017, the founder is Academician E.A. Vagner Perm State Medical University.

Editor-in-Chief: Evgeny G. Furman, MD, PhD, Corresponding Member of the Russian Academy of Sciences (Wagner State Medical University, Ministry of Health of the Russian Federation, Vice-Rector for Research)

The journal is registered by the Roskomnadzor agency (licensee ЭЛ № ФС 77-75489 on 05.04.2019).

“Perm Medical Journal” is included into the list of the leading scientific journals and editions of the Russian Federation intended for publication of basic scientific results of theses for a degree of Doctor of Science.

01.14.01 - Obstetrics and gynecology (medical sciences)
01.14.02 - Endocrinology (medical sciences)
3.1.21 - Pediatrics (medical sciences)
01.14.12 - Oncology (medical sciences)
3.1.9 - Surgery (medical sciences)
01.14.25 - Pulmonology (medical sciences)
3.2.2 - Epidemiology (medical sciences)
03.14.09 - Clinical immunology, allergology (medical sciences)
03.14.10 - Clinical laboratory diagnostics (medical sciences)


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Current Issue

Vol 38, No 2 (2021)

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Original studies
Staphylococcus aureus as a target of peripheral blood microbicidal factors from healthy donors
Godovalov A.P., Boev I.A.

Objective. The aim of investigation was to evaluate the bacteriolytic activity of the peripheral blood of healthy donors against S. aureus. Currently, much attention is paid to the involvement of opportunistic microorganisms in the development of infectious and inflammatory diseases, among which one of the leading places is occupied by the processes of staphylococcal etiology. Staphylococcus aureus possesses a unique spectrum of pathogenic factors, which, together with intracellular persistence, allow staphylococci to avoid exposure to immune factors and other agents.

Materials and methods. The bacteriolytic activity of the peripheral blood of 32 healthy donors, as well as the ability of the whole blood and serum to destroy biofilms, were evaluated. The phagocytic activity of peripheral blood monocytes and neutrophils and the ability to produce hydroxyl radicals were analyzed. For opsonization of S. aureus, a commercial immunoglobulin G or donor serum was used.

Results. It was shown that the whole peripheral blood practically does not have a significant effect on the number of viable cells of S. aureus. However, freshly obtained blood serum significantly destroys the biofilm. It has been established that a fifth part of peripheral blood leukocytes is absorbed by S. aureus. After opsonization of microbial cells with immunoglobulin G, the indices of phagocytic activity of monocytes and neutrophils did not change significantly. When using freshly obtained serum for opsonization of objects, a stimulating effect on the production of hydroxyl radicals by leukocytes was revealed (2758.7 ± 725.3 and 870.6 ± 197.4 related light units, respectively; p < 0.05). After heating the serum at 56 °C, the stimulating effect was leveled (1091.1 ± 234.7 related light units; p > 0.05 for samples with non-opsonized objects). In general, the obtained data indicate that the complement components can be recognized as the most effective system for the elimination of S. aureus.

Conclusions. Thus, S. aureus uniquely adapted to the human body that allows staphylococci to persist for a long time without clinical manifestations. It can be assumed that among the factors of the immune system, the proteins of the complement system, which destroy both S. aureus cells and the biofilm matrix, probably have the most effective bactericidal action. However, the effectiveness of this system depends on the protein-synthesizing function of the liver, the availability of microorganisms to the action of complement.

Perm Medical Journal. 2021;38(2):6-13
Substantiation of connection between affective disorders and development of malignant neoplasms of pancreas: experience of the center
Moiseenko V.E., Kardanova I.G., Pavlovsky A.V., Granov D.A., Rukavishnikov G.V., Mazo G.E.

Objective. To analyze the relationship between the affective disorders in the form of anxiety and depression and the development of pancreatic cancer and stomach cancer. Today, there is an interest to the relationship between changes in the emotional sphere of patients with malignant neoplasms (MNO) of the pancreas at the early stages of the disease, when there are no other clinically significant symptoms, which allow suspecting the disease at an early stage.

Materials and methods. A questionnaire survey was carried out in 63 patients with histologically verified cancer of the pancreas and stomach, who were treated at the FGBU RNTSRKhT named after Acad. A.M. Granov in the period from 2018 to 2020. The survey was conducted using the questionnaire of the European Organization for Research and Treatment of Cancer (EORTC-QLQ-C30 «Russian version») and the «Hospital Anxiety and Depression Scale (HADS)», Russian version. Statistical processing of treatment results was carried out using regression analysis and Mann-Whitney test with the SPSS statistical software package (Statistika 13.0). The probability of error p < 0.05 was considered sufficient to conclude that the differences in the data obtained were statistically significant.

Results. In a comparative assessment of the indicators of affective disorders in pancreatic cancer patients, there were noted more pronounced affective disorders, such as «feeling of depression», «feeling of irritation», «anxiety» and «tension», the values of which, according to the results of the analysis of questionnaires, were 1.00 ± 1, 1, 00 ± 1.00 ± 1 and 2.00 ± 1, respectively. In patients with gastric cancer, the values of these affective disorders, according to the survey results, were less pronounced and amounted to 3.00 ± 1.00 ± 1.00, 3.00 ± 1.00, 3.00 ± 1, respectively (p = 0.000).

Conclusions. Severe affective disorders, such as anxiety and depression, in patients with pancreatic cancer should be regarded as a factor of the early manifestation of the disease. Further study of this connection can create a theoretical basis for the development of specialized screening programs to identify patients in the «risk groups» for the development of pancreatic cancer.

Perm Medical Journal. 2021;38(2):14-22
Characteristics of physical qualities and vegetative regulation in adolescents with postural disorders
Nezhkina N.N., Kuligin O.V., Sokolovskaya S.V., Nasonova O.L., Mitrofanova G.N.

Objective. To characterize the physical qualities and autonomic regulation in adolescents with postural disorders.

Material and methods. 124 teenagers aged 16-17 including 58 boys and 66 girls were examined. There were 2 groups of patients: with postural disorders in the sagittal (n = 57) and frontal plane (n = 67). The examination program included an assessment of physical development, somatotype, general endurance and static endurance of the large muscles of the back and trunk, autonomic regulation by analyzing heart rate variability, levels of personal and situational anxiety, as well as self-esteem.

Results. Adolescents with impaired posture in the sagittal plane are characterized by the predominance of the asthenoid somatotype, a high frequency of body weight deficiency, a decrease in overall endurance, as well as endurance of the back and abdominal muscles, and a predominance of the activity of the parasympathetic autonomic nervous system. In this category of patients, the thoracic and muscular types of physique predominate in the frontal plane of postural disorders, and there is a significant asymmetry in the static endurance of the lateral muscles of the trunk, and an increase in the functional activity of the sympathetic autonomic nervous system. In both of these variants of postural disorders in adolescents, there is a high frequency of undifferentiated connective tissue dysplasia, sympathetic hyperreactivity, personal and situational anxiety, and a decrease in self-esteem.

Conclusions. Features of physical qualities, vegetative regulation and psychological sphere should be taken into account when developing differentiated programs for correcting posture in adolescents, depending on the plane of its violation.

Perm Medical Journal. 2021;38(2):23-29
Psychophysical training in treatment of sympathicotonic vegetative dystonia syndrome and primary arterial hypertension in children and adolescents
Nezhkina N.N., Kuligin O.V., Nasonova O.L., Mitrofanova G.N., Sokolovskaya S.V.

Objective. To evaluate the effectiveness of psychophysical training as a method of non-drug correction of vegetative dystonia syndrome of sympaticotonic type and primary arterial hypertension in children and adolescents.

Material and methods. 164 patients aged 7–17 years with sympathicotonic vegetative dystonia syndrome were examined, of which 47 were diagnosed primary arterial hypertension. The baseline autonomic tone (by cumulative clinical tables of autonomic manifestations), autonomic reactivity (based on the results of variation pulsography in ortho-and clean position), support activities (by clean orthostatic test) were evaluated, the heart rate variability was analyzed. As a method of non-drug correction of the functional state of the autonomic nervous system, psychophysical training (main group, n = 110) and therapeutic physical culture (comparison group, n = 54) were used. To assess the effectiveness of treatment, patients were examined twice: before and after the course.

Results. It was found that in the sympaticotonic type of vegetative system, excessive vegetative reactivity and activity maintenance predominate. The use of psychophysical training leads to their normalization in most patients. In patients with primary arterial hypertension, the level of blood pressure decreases. According to the analysis of heart rate variability in the main group there is a significant increase in the total power spectrum of neurohumoral regulation, representation of high-frequency fluctuations with simultaneous reduction of the share of low-frequency waves as well as aligned sympathetic-parasympathetic balance.

Conclusion. Psychophysical training is an effective method for non-drug correction of vegetative dystonia syndrome by sympaticotonic type and primary arterial hypertension in children and adolescents.

Perm Medical Journal. 2021;38(2):30-36
Fatigue as a symptom of neurological diseases
Baidina T.V., Kolesova T.I., Malinina Y.V., Trushnikova T.N., Danilova M.A.

Objective. The aim of the work was to study the fatigue syndrome in various organic brain diseases.

Materials and methods. Patients in the recovery period of hemispheric stroke, with Parkinson's disease and multiple sclerosis were examined. Along with the clinical one, there was conducted a study using the asthenia questionnaire MFI-20, FIS (Fatigue Impact Scale), FSS (Fatigue Severity Scale).

Results. It has been established that patients with various diseases of the central nervous system have a syndrome of fatigue, which is a nosogenic one, that is, a consequence of organic brain damage.

Perm Medical Journal. 2021;38(2):37-44
Modern approach to combination therapy in patients with pelvic inflammatory diseases
Khasanova V.V., Kukarskaya I.I., Shevlyukova T.P., Kukarskaya E.Y.

Objective. The aim of the study was to compare the efficiency of complex therapy of pelvic inflammatory diseases (PID) in patients using the drug Longidaza® and the effectiveness of therapy without the use of this drug.

Materials and methods. 150 patients of reproductive age with PID. All women underwent basic therapy. The complex treatment of group 1 included the additional drug Longidaza® in vaginal suppositories 3000 IU with the general course of 20 injections once every three days. The patients were observed for 60 days. The effectiveness of therapy was determined by the dynamics of diagnostic criteria (clinical and laboratory).

Results. During the follow-up period, among patients receiving complex therapy with Longidaza® relief of pain syndrome in the lower abdomen was observed much faster, and only 14 (18,5 %) women of group 1 continued to fill it after 2 months of treatment, where as in group 2 – 60 (81,1 %) patients (p < 0,001). Reduction of pain in palpation and cervical traction in patients of the main group was recorded in all (100 %) patients, while in the group of basic therapy this symptom continued to be observed in 23 % of women (p < 0.001). The dynamics of decrease in the share of patients with increased uterine size in group 1 was 14.9 % and in group 2 – only 8.4 % (p < 0.001). In the experimental group, during the 2-month follow-up period, there was observed an increase in the number of patients with a normal number of leukocytes in the vaginal smear by 13 %, while in the second group this parameter increased by only 3 % to the initial value.

Conclusions. The results of the research allow indicating the efficiency of treatment of PID when using the drug Longidaza®.

Perm Medical Journal. 2021;38(2):45-55
Review of literature
Role of focal laser retinal photocoagulation in treatment of diabetic macular edema
Ionkina I.V., Grinev A.G., Zherebtsova O.M.

Vascular endothelial growth factor (anti-VEGF) inhibitors in action have demonstrated efficacy and safety in the treatment of diabetic macular edema (DME), and have changed both the goal and prospects for treatment of this disease. Consequently, the role of focal laser retinal photocoagulation in the treatment of DME has been actively debated. However, technical advances in new laser systems, treatment protocols for anti-VEGF drug research, and the functional impact of modern focal photocoagulation are necessary to assess the role of laser coagulation in the treatment of DME. A wide range of clinical studies of laser therapy was necessary as an additional treatment for 20 to 50 % of patients receiving monotherapy with anti-VEGF drugs in patients with diabetic macular edema. In addition, a lower frequency of repeated treatment and a more stable reduction in retinal thickness have been demonstrated in other studies. However, the lack of information about the laser systems used, their technical characteristics, and application protocols often make it difficult to compare directly the results of anti-VEGF tests. Therefore, the aim of our work was to analyze the currently available data related to the potential role of focal laser photocoagulation in the treatment of DME, including a detailed review of the most commonly used laser systems. The results obtained with sub-threshold diode micro-pulse laser photocoagulation may be a valuable option as an adjunct therapy to treatment with angiogenesis inhibitors. Current evidence suggests that focal laser therapy should still exist as an adjunct therapy for many patients.

Perm Medical Journal. 2021;38(2):56-69
Methods of diagnosis and technologies
Сomparison of ultrasonic scanning and morphological data in patients with postmenopausal endometrial polypes
Kobaidze E.G., Matveeva Y.N.

The article discusses the features of obstetric and gynecological anamnesis in patients with endometrial polyps in the postmenopausal period, compares the ultrasound protocols and data of morphological examination of the surgical material (n = 100). The results showed that endometrial polyps are detected with the same frequency in patients in the early and late postmenopausal period. It is noteworthy that every five patient with an endometrial polyp in the reproductive age had menstrual dysfunction and a high frequency of using intrauterine contraceptive. In order to verify the pathology of the uterine cavity, ultrasound infusion sonography was not used in the studied group of patients. There was a high frequency of the absence of visualization of endometrial polyps on TV ultrasound, besides, they were frequently verified as endometrial hyperplasia; overdiagnosis took place in more than 7.5 cases; morphological examination confirmed hyperplasia only in 8% of 60 % of patients. It is important to note that in case of malignant endometrial processes, TV ultrasound did not reveal even a suspicion of this. All of the above allows us to say that there is a need for further study of the tactics of managing patients with endometrial pathology in the postmenopausal period.

Perm Medical Journal. 2021;38(2):70-78
Preventive and social medicine
Features of dental status in senior schoolchildren depending on mineral composition of drinking water
Mozgovaya L.A., Sivak E.Y., Sosnin D.Y., Gavrilenko M.S., Fokina N.B., Mozgovaya S.V.

Objective. Hygienic assessment of the quality of drinking water from two rivers, Kama and Chusovaya, which supply the city of Perm, was carried out. Water in them is different in mineral composition, but similar in terms of anthropogenic pollution.

Materials and methods. Dental status was determined in 142 schoolchildren aged 15-17 years old, who use water from different sources. The concentration of total calcium and magnesium in the oral fluid was determined for all schoolchildren.

Results. The study found that the degree of mineralization of drinking water affects the mineral composition of the saliva. Schoolchildren, who use drinking water of low mineralization, have a low concentration of calcium and magnesium in the saliva and a high intensity of dental caries. Schoolchildren, who use drinking water of increased mineralization, have a high concentration of calcium and magnesium in the saliva, a low intensity of dental caries and a high intensity of periodontal diseases due to an increased formation of tartar. Treatment and preventive measures, carried out among schoolchildren, included the drug «Complivit», plates «CM 1», low-intensity laser light.

Conclusions. The effectiveness of treatment and preventive measures was determined by the activity of the oral fluid enzymes before and after the course of treatment.

Perm Medical Journal. 2021;38(2):79-87
A new way to optimize primary prevention of bleeding from varicose veins of esophagus
Budarev V.N.

Objective. To establish the possibility of optimization of drug prevention of bleeding from varicose veins of the esophagus based on the influence of meteorological factors on the development of the disease.

Materials and methods. The results of examination and treatment of 86 patients diagnosed bleeding from varicose veins of the esophagus, who were treated at the Emergency Hospital of Ryazan in 2016-2018, were analyzed.

Results. A significant dependence of the incidence of bleeding from varicose veins of the esophagus on meteorological factors, in particular, on changes in atmospheric pressure, was revealed. Based on the analysis of the weather data archive, the safest periods for temporary interruption of the courses of drug primary prevention were established.

Conclusions. A break in the course of primary drug prevention of bleeding from varicose veins of the esophagus, necessary to increase its effectiveness, will be the safest in February and July.

Perm Medical Journal. 2021;38(2):88-94
Prognostic value of assessment of glial cell line-derived neurotrophic factor in ischemic stroke patients
Kurakina A.S., Semenova T.N., Schelchkova N.A., Guzanova E.V., Mukhina I.V., Karakulova J.V., Grigorieva V.N.

Objective. The aim of the study was to estimate the prognostic value of GDNF in acute IS patients. Glial neurotrophic factor (GDNF) is a neuropeptide, which promotes the proliferation and differentiation of the cells of the central and peripheral nervous system, possesses antihypoxic and neuroprotective properties in ischemic stroke (IS).

Materials and methods. 50 patients with first-ever acute IS were examined at the National Institutes of Health Stroke Scale (NIHSS); modified Rankin scale was used on admission to the hospital, 7 and 14 days after stroke. The plasma GDNF level was measured at the first 48 hours and after 7 days of IS onset. GDNF was analyzed by commercially available ELISA kit. The comparison group included 20 healthy persons.

Results. The average GDNF level in the group of patients with IS (3.4 [2.8; 5.0] pg/ml) was significantly higher than in the group of healthy individuals (2.8 [2.6; 2.9] pg/ml), p = 0.02.

The risk of unfavourable functional outcome on the day 14 after IS onset was higher by 2.8-fold in those patients whose level of GDNF was increased on the 7th day of the disease by more than 30% compared to its level in the first 48 hours (RR = 2,8; 95% CI [1,4–5,7]).

The GDNF level less than 2.9 pg/ml was associated with a high risk of death during 14 days after the IS onset (RR = 6,7; 95% CI [1,5–30,5]).

Conclusions. Plasma concentrations of GDNF have a high predictive value for unfavorable functional outcome and risk of death in acute period of IS.

Perm Medical Journal. 2021;38(2):95-102
Сhange in figurative ideas of women’s quality of life depending on age
Kamilova N.M., Guliyeva L.A.

Objective. To assess the quality of life of refugee women.

Material and methods. 149 refugee women, who are close relatives in three generations, were examined and divided into 3 groups depending on their age: Group I – 51 women aged 18–35 years, group II – 61 women aged 36–54 and group III – 34 women aged 55 and over. The quality of life was assessed in two main ways: by self-assessment (subjective method) and by doctors (objective approach). The studies regarding the quality of life were carried out in accordance with the general principles of sociological research. The assessment was realized in points for each criterion. The maximum scale corresponds to 100 points. Along with this program, the international standardized questionnaire SF-36 was used in addition.

Results. The data we obtained in the course of the study, first of all indicate the importance of the life priorities of the subjects examined and must be taken into account when planning measures to improve the quality of health.

Conclusions. Comparative analysis of health-related quality of life indicators showed that among women parameters of physical functioning significantly decrease with age, regardless of the hierarchy of life priorities. Psychological components increase in middle-aged women with the life priority “work”.

Perm Medical Journal. 2021;38(2):103-110
Clinical case
Studying of dynamics of Alzheimer's disease symptoms manifestation against the background of COVID-19 in department № 5 for treatment of COVID-19, city clinical hospital № 2 named after F.H. Gral
Karakulova Y.V., Sokolova E.S., Palamarenko M.A., Koryakin E.S., Novikov A.A., Trushnikova T.N.

A clinical case was analyzed, the regularity and dynamics of psychoneurological symptoms was studied in a patient with a moderately severe form of the course of a new coronavirus infection with concomitant neurodegenerative disease – Alzheimer's disease.

The patient aged 73 was admitted to the City Clinical Hospital №2 named after F.H. Gral by the team of emergency care with identified COVID-19. When admitted to the hospital, she had disability group 2 regarding neurodegenerative disease – Alzheimer's disease. A multispiral computed tomography of the head revealed the following: internal open substitutional hydrocephalus, moderately expressed bilateral leukoaraiosis, cerebral atrophy, predominantly in temporoparietal region, that is typical for Alzheimer's disease.

The results of tests indicated a decrease in cognitive status. In the test with figures, the patient could not find the required figure for the desired time. When conducting “clock-drawing test” in dynamics, at the second attempt the patient needed about 7 minutes; a worse capability for drawing was noted; apraxia was observed. The result of the test “6CIT” at the second attempt, carried out before discharge from the hospital became worse – she could answer only one of four questions, whereas at the first attempt, when admitted, she could answer two questions of four. By the time of discharge from the hospital, the patient was noted to have more pronounced cognitive disorders than at admission. Emotional lability, nervousness and anxiety also remain.

Perm Medical Journal. 2021;38(2):111-119
Biology and experimental medicine
Evaluation of sensitivity to chemical disinfectants of mycobacterium tuberculosis strains isolated from HIV-infected individuals and patients with monotuberculosis infection compared to the reference strain
Sergevnin V.I., Tukacheva O.V., Sibiryakova О.R., Sarmometov E.V., Azanov P.B.

Objective. To study the sensitivity to chemical disinfectants against Mycobacterium tuberculosis isolated from HIV-infected individuals and patients with monotuberculosis in comparison to the reference strain of Mycobacterium terrae.

Materials and methods. The sensitivity of 12 M. tuberculosis strains isolated from patients with HIV-associated tuberculosis (n = 6) and monotuberculosis (n = 6) to chlorine-containing and quaternary ammonium compound (QAC) disinfectants was studied. The M. terrae strain was used as a reference. Seedings of microbial suspensions treated with disinfectants on the culture medium Levenshtein-Jensen were carried out and were monitored for 3 months.

Results. One, two, three months following the treatment of microorganisms with QAC-containing disinfectant in the absence of growth of the control strain, there was noted growth of M. tuberculosis, particularly intense in the strains isolated from HIV-infected persons.

Conclusions. Thus, the resistance of tuberculosis pathogens to disinfectants can be acquired.

M. tuberculosis strains isolated from patients with HIV-associated tuberculosis are detected to be more resistant to disinfectants than the strains isolated from patients with monotubercular infection.

Perm Medical Journal. 2021;38(2):120-125
Parasitic contamination of soil in astrakhan region. analysis of work in 2010–2019
Irdeeva V.A., Shemetova S.A., Arakelyuan R.S., Shendo G.L., Polyanskaya N.V.

Objective. We studied the contamination of the soil with helminth-protozoan infestations in Astrakhan region for 2010–2019.

Materials and methods. The research work was carried out in the Laboratory of Bacteriological and Parasitological Research of the Center for Hygiene and Epidemiology in the Astrakhan Region in 2010–2019. A total of 10 692 soil samples were examined, and 11 384 studies were performed. The number of samples, which did not meet the sanitary and parasitological indicators was 7.0 % (753 samples). Eggs and larvae of helminths, as well as cysts of pathogenic intestinal protozoa were found in these samples.

Results. During the analyzed period, 86 491 samples of sanitary and parasitological studies were selected and examined in the Astrakhan region, of which 93.6 % (80 962 samples) were samples taken from various environmental objects (water, soil, manure, flushes from solid household surfaces). The total share of soil samples in the structure of all studies of environmental objects was 13.2 % (10 692 samples).

Conclusions. Parasitic contamination of the soil remains tense, as evidenced by positive findings in the form of eggs and larvae of helminths, as well as cysts of pathogenic intestinal protozoa. The presence of toxocara eggs and strongylid larvae in the soil indicates contamination of this object with the feces of infected animals. The presence of eggs of ascarids, opisthorchis, pygmy tapeworm and cysts of dysentery amoeba in the soil may indicate that this object is contaminated with the feces of persons with parasitic infestation, or about accidents on the sewer network and underflooding of soil sampling sites.

Perm Medical Journal. 2021;38(2):126-132
Anniversaries and information on events
Eightieth anniversary of department of epidemiology of E.A. Vagner perm state medical university
Feldblyum I.V., Sergevnin V.I., Subbotina K.A., Menshikova M.G., Bikmieva A.V., Devyatkov M.Y., Golodnova S.O.

The paper presents historical stages in the development of the Department of Epidemiology and Hygiene of E.A. Vagner Perm State Medical University. The evolution of technologies, forms and methods used in educational process are described. There are formulated the directions of activity of the department and the experience of work with organs and institutions of public health and Rospotrebnadzor.

Perm Medical Journal. 2021;38(2):133-141

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